title: Development of a pulmonary rehabilitation service for people with COPD: a tiered model of integrated care.
abstract: OBJECTIVE
  Pulmonary rehabilitation (PR) services often are used for people with chronic obstructive pulmonary disease (COPD). This study describes the development and evaluation of a tiered service in North Tyneside, United Kingdom, which aimed to increase access to PR without negatively affecting clinical outcomes.
  
  
  METHODS
  Data were collected retrospectively. Subjects, identified as having COPD by their general practitioner, based on spirometry, were tiered for PR on the basis of their dyspnea score. Tier 1 (1-2 dyspnea score) patients were prescribed exercise and referred to an exercise program. Those in tier 2 (3-4 dyspnea score) were referred to a specialized "healthy living" exercise and education group run by an exercise health trainer. Those scoring 4 (tier 3) received physiotherapist-led group exercise and education classes. Those scoring 5 were seen at home by trained health care professionals. Scores in the Chronic Respiratory Diseases Questionnaire, COPD assessment test, and 6-minute walk test were recorded at baseline and immediately after rehabilitation.
  
  
  RESULTS
  Data were available for 199 cases recruited. Four patients (2.0%) were placed into tier 1, 107 (53.8%) into tier 2, 85 (42.7%) into tier 3, and 3 (1.5%) into tier 4. Because of the small number involved, data for tiers 1 and 4 were not analyzed further. In tiers 2 and 3, there was a significant improvement in performance across all 3 outcome measures.
  
  
  CONCLUSIONS
  Tiered PR may be an effective way of increasing access to PR services. Further prospective data are needed to evaluate the service fully with regard to patient throughput and costs.
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom. Gbenga.Afolabi@nhct.nhs.uk
authors.forename: Gbenga
authors.initials: G
authors.lastname: Afolabi
authors.forename: Ruth
authors.initials: R
authors.lastname: Stevens
authors.forename: Maureen
authors.initials: M
authors.lastname: Turner
authors.forename: Marguerite
authors.initials: M
authors.lastname: Harvey
authors.forename: Liz
authors.initials: L
authors.lastname: Norman
authors.forename: Sian
authors.initials: S
authors.lastname: Dogan
authors.forename: William K
authors.initials: WK
authors.lastname: Gray
mesh_terms: D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D004417:Dyspnea / Q000503:physiopathology* / Q000534:rehabilitation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D012138:Respiratory Therapy; D012189:Retrospective Studies; D013147:Spirometry; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom